For some time, Reproductive endocrinologists believe that PCOS is associated with psychology problems. This general opinion was affirmed in the most recent edition of Human Reproduction (2011: 26: 1399). Deeks et al reported on a study involving 177 women with the diagnosis of PCOS. The authors tested the participants with a number of psychological tests designed to diagnose anxiety and/or depression. Women with PCOS were more likely to have problems with self-worth and body image. Women with PCOS also had higher levels of anxiety and depression. The problems with depression and anxiety occurred independent from weight and seemed to be related to the PCOS itself.
Interestingly, the longer it took to diagnose the problem the greater the levels of anxiety and depression. This finding becomes important when combined with the results of a study done in 2010 by March et (Hum. Reprod. 2010:25;544). The study by March attempted to determine how many women had PCOS. The authors attempted to contact 728 women who delivered a child at the hospital where the authors performed the study. Of the 728 women who consecutively gave birth 52% responded. The authors used the three most popularly used definitions to determine what percent of this population actually met the requirements in order to have a diagnosis of PCOS.
They determined that between 9% and12% met the criteria for the diagnosis of PCOS. If the results were adjusted to include those women who did not agree to have an ultrasound, blood tests and a physical exam the actual percent of women with PCOS was as high as 18% of the women questioned. The most concerning finding from this study was that 70% of the women questioned did not realize that they met the criteria for PCOS. The implications are clear in that many women may have anxiety or depression and not realize that the cause could be PCOS.
The diagnosis of PCOS is controversial but the three leading definitions all have clinically increased ovarian male hormone production (androgens). All definitions require excluding other diseases which may appear as PCOS but are not. One definition- the 2003 Rotterdam Criteria- suggest that for the diagnosis of PCOS a women must have two of the following three findings: 1.irregular to no periods; 2. clinical androgenism such as unwanted hair or acne or increased blood levels of androgens.; 3. polycystic ovaries by ultrasound. Many women with PCOS have increased weight or problems with glucose metabolism in the form of inefficient insulin (insulin resistance). The importance of this information is that knowing that insulin and weight are key promoters of PCOS establishes a beginning for treatment that does not involve medication.
Weight control is very difficult and to date not successfully treated by medicine. However, women can do two things which will improve their health and lessen the symptoms of PCOS. The first is exercise. A recent study by Harrison et al (2010) found that significant results could be achieved for people with PCOS by exercising at least 90 minutes per week at a moderate level of exercise which was about 60% of their maximal ability. This would be equivalent to a brisk walk of 20 – 30 minutes at least 4-5 days a week where the heart rate rose above 135-140 beats per minutes.
The critical aspect of exercise for PCOS is the need to do the exercise consistently (on most days) but not necessarily vigorously. The second lifestyle alteration that women with PCOS can make is to limit their carbohydrate intake. A very simple rule is that anytime a person with PCOS can reduce their intake from food that was made from something white they will be reducing the need to release insulin and hopefully reducing the symptoms of their PCOS. These are simple, yet difficult, lifestyle changes that can make a difference in how a person feels and how they feel about themselves. There are medical therapies that can be used for more severe PCOS if the simple lifestyle changes are not sufficient.